Surgery LAB MIDTERM

what is ‘A’ in SOAP for tech notes

Assessment - the analysis of all subjective and objective data in order of importance

what is ‘S’ in SOAP for tech notes

Subjective - all non measurable information

what is ‘O’ in SOAP for tech notes

all measurable information

what is ‘P’ in SOAP for tech notes

developing a plan to address each assessment

what is the goal of preop physical exam

determine patient abnormalities and risk factors for anesthesia and surgery

vitals part of the preop exam

• temp

• HR

• RR and effort

• pain score

• MM and CRT

side effects of opioids in cats

excitation, hyperthermia, mydriasis

side effects of opioids in dogs

sedation, hypothermia, miosis

side effects of opioids in dogs and cats

Hypersalivation, urine retention, reduced GI motility, cough suppression, nausea and vomiting. Dose dependant bradycardia and respiratory depression

side effects of dissociative anesthetic agents

increased muscle tone, jerking mvmts and tremors

eyes remain open and dilated, possible nystagmus

increased sensitivity to light and sound

increased CSF pressure and increased IOP

respiratory depression, cardiac arrhythmias

increased HR and BP (w/o decrease in CO)

examples of dissociative drugs

ketamine, telazol

benefits of dissociatives

• can be absorbed through MM or eye

• NMDA receptors antagonists

• provides analgesia which lowers the dose of opioids necessary

• prevents severe acute pain and chronic pain

CONTROLLED SUBSTANCE schedule class of dissociative drugs

schedule 3

what class is ketamine

schedule 3

what class is telazol

schedule 3

benefits of alpha-2 adrenergic agonist

good sedatives, analgesics, and muscle relaxation

examples of alpha-2 adrenergic agonist

dexdomitor and xylazine

alpha-2 adrenergic agonist side effects

vomiting, defecation, bradycardia

respiratory depression with high doses, initial hypertension followed by hypotension, cardiac arrhythmias, muscle tremors, sudden arousal especially to loud noises, hypothermia

benefits of phenothiazine tranquilizers

mild to moderate sedation, antiemetic, minimal respiratory effects, long duration

side effects of phenothiazine tranquilizers (acepromazine)

peripheral vasodilation causing hypotension and hypothermia, elevated third eyelid, paradoxical excitement or aggression

side effects of benzodiazepines

excitement, anxiety, difficult to control pt when given alone or at high doses

use caution in pt with hepatic or renal dz, glaucoma, or those that are very sick/debilitatedm

benefits of benzodiazepines

mild to moderate sedation, anti-anxiety, muscle relaxation, minimal effects on cardiopulmonary system

class of benzodiazepines

schedule 4

which benzodiazepine has better absorption and is water soluble

midazolam

side effects of anticholinergic meds

dry mouth, tachycardia, mydriasis, respiratory depression, ataxia

what species has a high level of atropinase and why is it important

rabbits!

they need higher doses of atropine to treat bradycardia

what is the goal with parasympatholytic drugs

to decrease secretions, maintain HR, decrease CNS activity, decrease ability to sweat, reduce GI spasm

what anticholinergic would you use for rabbits and why

glycopyrrolate

b/c they have higher levels of atropinase and need to anticholinergic to treat bradycardia

plant based belladonna

atropine

how long does propofol last

2-5 minutes

how long does it take propofol to work

w/i 30-60 seconds

side effects of propofol

apnea, bradycardia, hypotension if rapid injection

seizures

is propofol toxic to cats

yes on repeated administration

halogenated inhalant agents - isoflurane, sevoflurane

can be irritating to the airways especially with ask to chamber induction

can induce malignant hyperthermia in sensitive animals

examples of neuroleptanalgesia

acepromazine/butorphanol

acepromazine/buprenorphine

full mu opioids

morphine, fentanyl, hydromorphone, and methadone

partial mu agonist

buprenorphine (buprenex)

mixed mu antagonist

butorphanol (torb)

has a better sedative than analgesic

what drug induces a state of catalepsy which produced immobilization by not surgical plan of anesthia

dissociatives

glycopyrrolate

synthetic anticholingeric that has an improved ability to reduce secretion and gastric acid with less tachycardia and sedation

more costly

what is a neuroleptanalgesia

a combination of a strong neuroleptic tranquilizer with a potent opioid to produce a detached pain free state

alfaxan method of action

GABAa agonist

how is alfaxan given

IM or IV

benefits of alfaxan

similar to propofol’s side effects and is ultra short acting.

can cause apnea and respiratory depression but usually less than propofol

Halogenated inhalant agents

isoflurane, sevoflurane

halogenated inhalant effects

CNS depression, hypothermia, and muscle relaxation

disadvantages to halogenated inhalants

Can be irritating to Airways especially with mask or chamber induction

can induce malignant hypothermia and sensitive animals such as dogs pigs and humans

must have a precision vaporizer

Advantages to halogenated inhalant agents

Rapid induction

quick recoveries

changes to anesthetic depth

respiratory depression and hypotension are dose dependent

why use Injectable CRI/ TIVA agents for maintenance anesthesia

shortened recovery time and decreased PO nausea and vomiting

TIVA

total intravenous anesthesia

gabapentin

analgesic and anxiolytic

NSAID

anti-inflammatories

Antibiotics

antibiotic stewardship

local blocks

dental, ring, testicular, and line/incisional blocks

starting fluid rate for dogs in sx

5ml/kg/1st hr

starting fluid rate for cats in sx

3ml/kg/1st hr

antiemetic/ GI medications

to prevent pre op and post op nausea and vomiting which can lead to complications like anorexia, aspiration pneumonia and esophagitis and/or stricture

cerenia (maropitant)

neurokinin (NK-1) receptor antagonist (antiemetic)

metoclopramide/reglan

prokinetic

prevents aspiration pneumonia

better on upper GI tract

Ondanestron

5-HT3 receptor antagonist

blocks the signal to the brain for nausea (similar to cerenia)

Pantoprazole/Omeprazole

proton pump inhibitor (reduce acid)

Needle Holders

Mayo-Hegar

Olson-Hegar

scissors

metzenbaum

mayo

littauer suture scissor

lister bandage scissor

forceps

hartman mosquito forcep

halstead mosquito forcep

crile forcep

kelly forcep

rochester carmalt

allis tissue forceps

babcock intestinal forcep

backhaus towel forceps

forester sponge holding forceps

thumb forcep

adson

adson brown

dressing forceps

rat tooth

what are the required minimum settings for autoclave

15 psi, 250F for 15 minutes

but its usually run for 30-60 minutes

how long is cloth wrap alone good for

2 months

how long is plastic/paper patches stored in closed shelf/drawer or container good for

1 year

how long is paper/polypropylene with single layer wrap stored in open shelf good for

6 months

what is the standard O2 flow rate

1-2 L/min

how do you prevent rust on instruments during the autoclave process

dry prior to packing

how do you prevent mineral deposits on autoclave machine or instruments

always use distilled water

what is the goal of general anesthesia

characterized by unconsciousness and insensibility to feeling and pain induced by administration of anesthetic agents given alone or in combination.

provide an environment in which general surgery or other painful procedures can be performed without the danger of patient movement or injury to personnel.

what is induction

the process that is used to take the patient from a state of consciousness to general anesthesia.

what is maintenance

Maintenance of anesthesia is the process used to keep the patient under general anesthesia until recovery.

what does the o2 flow meter do

alters the PSI from the tank

what controls the O2 flow rate to the patient

flowmeter

what is the o2 flow rate after induction and during recovery to change anesthetic depth

50-100 ml/kg/min

MAX 5L/min

what is the o2 flow rate during maintenance

low flow: 20-40 ml/kg/min MINIMUM 0.5L/min

high flow: 200-300 ml/kg/min, MAXIMYM 5L/min

what is the o2 flow rate for non rebreathing systems

200-300 ml/kg/min

minimum 0.5L/min

disadvantages of non-breathing bag

• does not conserve gases, moisture or body heat

• more diffulcult to manually ventialte

advantages to non-rebreathing bag

• reduced dead space in circuit

• quick adjustments in anesthetic depth

what is tidal volume

10-15 ml/kg

how do you calculate reservoir bag size

bag should hold at least 5-6 times the tidal volume, then round up

sooooo

KG tidal volume (10-15 ml/kg) * 6

what do you do if the bag is over distended

1. check pop off valve ( closed probably)

2. check scavenging system ( obstructed probably)

3. check o2 flow rate (too high probably)

what do you do if the bag is not full enough

1. check for a leak

2. check scavenging ( probably too high)

3. check o2 rate ( too low)

soda lime

passively removes exhaled CO2 to prevent rebreathing

must be changed every 6-8 hours or when 1/3 to ½ of the granules are saturated

active scavenging

vacuum to remove WAGs

passive scavenging

F/air canister activated charcoal

what should you do with your f/air canister

must be weighed before use and daily so it can be changed once it gains 50 gram

precision vaporizer

holds the liquid inhalant anesthetic and delivers anesthetic gas independent of temperature, oxygen flow rate (within a range), respiratory rate and back pressure

what colour is iso

purple/fuchsia

what color is sevo

yellow

what is the ideal fill level for the anesthetic gas into the vaporized

halfway full

how can you estimate the size ET tube that you might need

gauge space between nares

supplies for intubation

• Appropriately sized endotracheal tube (at least 3 tubes)

• Small amount of sterile, water soluble lubricant

• IV tubing or roll gauze to tie in tube

• Gauze to grasp the tongue

• Syringe to inflate cuff (6-12cc syringe usually adequate)

• Laryngoscope or good light to visualize larynx

• Stylette

• ● +/- lidocaine for laryngospasm in cats

what does PCV/TP test

anemia

hypoproteinemia

dehydration

if the pcv is high what does that indicate (***)

dehydration

if the pcv is low what can it indicate

anemia

what does the BG test for

hyper/hypoglycemia